HEALTH FACTORS Health Behaviors Adult Tobacco Use Adolescent Alcohol Use Healthy Eating School Food Environment Physical Activity 1
Adult Tobacco Use Definition: For this assessment, adult tobacco use is defined as adults (18+ years of age) currently using cigars, cigarettes, chewing tobacco, snuff, or snus. Specifically, a current smoker has smoked at least 100 cigarettes in his/her lifetime and now smokes every day or some days. Tobacco use was assessed during the 2013 CHNA Survey. Data Sources: Centers for Disease Control and Prevention; Healthy People 2020; Minnesota Department of Health, Minnesota Adult Tobacco Survey; Olmsted County Community Health Needs Assessment (CHNA) 2013 Survey Community Health Importance: Smoking harms nearly every organ of the body, causing many diseases and affecting the general health of smokers and their close contacts. Tobacco use is the single most preventable cause of death and disease in the United States; tobacco use accounts for approximately 443,000 deaths or 1 of every 5 deaths in the United States each year. In addition, tobacco use costs the US $193 billion annually in direct medical expenses and lost productivity. What does this Health Factor Impact or Influence? Compared with nonsmokers, tobacco use is estimated to increase the risk of coronary heart disease and stroke (2-4 times), the development of lung cancer, and dying from chronic obstructive lung diseases. Every year, more deaths are caused by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Additionally, research has shown that smoking during pregnancy causes health problems for both mothers and babies, such as pregnancy complications, premature births, low birth weight infants, stillbirths, and has been linked with Sudden Infant Death Syndrome (SIDS). Current Community Perception: According to the 2013 CHNA Survey, smoking was noted to be one of the most pressing community health issues impacting Olmsted County. Tobacco use, secondhand exposure and the impacts of tobacco were discussed during the community listening sessions. Smoking cessation was mentioned as a top theme within preventive care and activities. Chronic disease overall, which tobacco impacts, was identified as a major community health concern. Current Level of Community Capacity: Current efforts in the community around tobacco use center on policy development, which includes: Freedom to Breathe Act/Smoke Free Workplaces; Smoke Free Ordinances; Smoke Free Multi-Unit Housing. Area of Greatest Opportunity: Preventing tobacco use and helping tobacco users quit can improve the health and quality of life for Americans of all ages. People who stop smoking greatly reduce their risk of disease and premature death. Effects of tobacco can be significantly reduced by strengthening County ordinances that deal with smoke/tobacco free locations, access and workplaces. 2
Trend Data with Goal: Both national and Minnesota smoking prevalence rates have been declining steadily over the past several decades. According to the most recent survey data available (2010), smoking prevalence rates currently in the US are at 19.9% where Minnesota rates are at 16.1%. Information gathered from the 2013 CHNA Survey indicates that 9% of Olmsted County adults currently smoke; this percentage would equate to approximately 10,000 adults county-wide. [Interpret local data with caution due to having only one data point; local data trending is not available.] Healthy People 2020 has a broad goal of reducing illness, disability and death related to tobacco use and secondhand smoke exposure. One specific objective is to reduce cigarette smoking by adults from the baseline of 20.6% (2008) to 12.0%. Health Inequities: There are many demographic health inequities associated with smoking status: smoking rates tend to decline as age, education and income increase. These well known inequities are consistent with Olmsted County data the highest smoking prevalence rates are seen among individuals with household income below $35,000 (23.8%) and non-college graduates (16%). Adult Tobacco Use 3
Adolescent Alcohol Use Definition: Adolescent alcohol use, in this assessment, is defined as Olmsted County students (6 th, 9 th, and 12 th graders) participating in the Minnesota Student Survey (MSS) who have reported any alcohol use in the past 30 days (MSS definition). Data Sources: Centers for Disease Control and Prevention (CDC), High School Youth Risk Behavioral Surveillance; Healthy People 2020; Minnesota Department of Health, Minnesota Student Survey (MSS); Substance Use in Minnesota (sumn.org) Community Health Importance: Adolescent alcohol use is a major community health problem. Alcohol is the most commonly used and abused drug among youth in the United States, and is responsible for more than 4,700 annual deaths among underage youth. There are many future health and life implications and consequences for adolescents who drink alcohol. What does this Health Factor Impact or Influence? Alcohol use has major impacts on individuals, families, and communities. The effects of its use and abuse are cumulative significantly contributing to costly social, physical, mental and public health problems including: school, social, legal and physical problems; unwanted, unplanned, and unprotected sexual activity; physical and sexual assault; alcohol-related car crashes and other unintentional injuries; crime; abuse of other drugs; changes in brain development that may have life-long effects; and death from alcohol poisoning. Current Community Perception: Olmsted County Public Health Services participated in Key Informant and One-on-One interviews (Summer 2012) to assess the community s knowledge and readiness to change regarding adolescent and young adult alcohol use. Community members thought adolescent alcohol use was a major issue in Olmsted County; however, the severity of the problem varied greatly, mostly due to personal experience and awareness. Current Level of Community Capacity: The Alcohol Misuse Prevention Coalition for Olmsted County, initiated in 2012, is currently providing, enhancing, and impacting the education and advocacy on alcohol abuse and misuse prevention. Membership spans across many sectors of Olmsted County including: youth and young adults, parents, school, law enforcement, and local government. The Somali Council and Zumbro Valley Mental Health Center also address adolescent alcohol use. Area of Greatest Opportunity: Reducing youth s easy social access to alcohol (i.e., getting alcohol from older friends, at parties, etc.) would substantially reduce consumption of alcohol among adolescents. 4
Trend Data with Goal: Over the past decade, Olmsted County has seen a decrease in adolescent alcohol use, and this trend continues. This decrease is most notably seen in 12 th graders, who also represent the cohort with the highest consumption use. During the most recent MSS (2010), it is noted that 35% of 12 th graders in Olmsted County have consumed at least one alcoholic drink within the past 30 days. Healthy People 2020 has a goal of reducing substance abuse to ultimately protect the health, safety, and quality of life for all, especially children. Specific to adolescent alcohol use, Healthy People 2020 objective is to reduce the proportion of adolescents reporting use of alcohol (or any illicit drugs) during the past 30 days by 10% from a baseline of 18.4% (2008) to 16.6%. Health Inequities: According to National surveillance data, differences remain in consumption of alcohol between gender and race groups. Among 12th grade students, males consume alcohol more than females (51.2% vs. 45.4%, respectively). Regardless of age or grade level, more white (40.3%) and Hispanic (42.3%) students consume alcohol than any other race or ethnic group (black 30.5%; Asian 25.6%). Adolescent Alcohol Use 5
Healthy Eating Definition: An individual meeting the national dietary guidelines for fruit and vegetables needs to consume at least 5 combined daily servings. For this assessment, fruit and vegetable consumption was assessed during the 2013 CHNA Survey. Individuals (age 18+) were given a brief description of what a serving consisted of, and then were asked separately: On average, how many servings of fruit (vegetables) do you consume daily? Data Sources: Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS); Healthy People 2020; Olmsted County Community Health Needs Assessment (CHNA) 2013 Survey; Rochester Behavioral Risk Factor Surveillance System, 2010 Community Health Importance: Healthful diets and body weights are directly related to health status. Good nutrition is important to the growth and development of children. There are many future health and life risks, implications, and consequences associated with consuming an unhealthy diet which includes those without adequate fruits and vegetables. What does this Health Factor Impact or Influence? Healthy diets rich in fruits and vegetables have been shown to reduce many health conditions, including: overweight and obesity, heart disease, high blood pressure, dyslipidemia, type II diabetes, oral disease, and some cancers. Current Community Perception: There is general consensus that fruits and vegetables are an important component of a healthy diet, however not everyone incorporates the recommended amount into their diet. Potential barriers to not consuming the recommended amount include: fruits and vegetables go bad too quickly; do not satisfy hunger; not available in homes; high cost; concerns about preparation time; and not knowing how to add more servings of each to their diet. According to the 2013 CHNA Survey, obesity was cited as the most pressing community health issue impacting Olmsted County; diet and healthy eating were also among the top issues mentioned. Additionally, individuals believe that diet, healthy eating, nutrition, and weight loss are all top types of public health information that would be useful for them or their family. Current Level of Community Capacity: There are many current community initiatives that promote eating more fruits and vegetables, including: Eat Smart, Be Smart (Rochester Community and Technical College); Healthy Concessions (Mayo Field); Farmers Market expansions and the acceptance of Electronic Benefits Transfer (EBT); Farm to School programs; and the regional Food Policy Council. Area of Greatest Opportunity: Diet reflects the variety of foods and beverages consumed over time and in settings such as worksites, schools, restaurants, and the home. Interventions to support a healthier diet potentially include: promoting the availability of healthier food retailers in communities, promoting the availability of healthier foods and nutrition services in schools, and encouraging overall food system support. 6
Trend Data with Goal: According to the most recent survey data available (BRFSS, 2009), approximately 25% of Minnesota and US adults meet the fruit and vegetable dietary guidelines. Information gathered from the 2013 CHNA Survey indicates that 50% of Olmsted County adults currently meet the recommended guidelines of eating 5 or more servings of fruits and vegetables. A survey completed with just Rochester residents in 2010 indicated that 17% of adults consume the recommended amount. [Interpret local data with caution due to differences in sampling and question design between survey years.] Healthy People 2020 has a broad nutrition and weight goal of promoting health and reducing chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. The specific objective around food consumption is to increase the contribution of fruits and total vegetables to the diets of the population aged 2 years and older. The measurement for this objective is not given by daily servings, so no comparison is feasible to the presented data. Health Inequities: Demographic characteristics of those with a more healthful diet vary from study to study. However, it is typically shown that most Americans need to improve some aspect of their diet. According to local data, the biggest difference in fruit and vegetable consumption is seen across education level. Approximately 60% of college graduates report consuming 5 or more servings a day; where only 40% of non-college graduates report meeting the nutritional guideline. Healthy Eating 7
School Food Environment* Definition: School food environments consist of many different factors all relating to food presence and availability on school campuses, including lunch [breakfast] program, vending machines, concessions, gardens, and advertising (i.e. posters). Specifically for this assessment, factors that are addressed are healthy snack carts and nutritional school gardens. Data Sources: Centers for Disease Control and Prevention (CDC), Children s Food Environment State Indicator Report; Healthy People 2020; Olmsted County Public Health Services Community Health Importance: The environments to which children are exposed in their daily lives schools, homes, and their communities can influence the healthfulness of their diets. For many children, the majority of their daylight hours are spent in school or at school-related functions. Therefore, schools are uniquely positioned to facilitate and reinforce healthful eating behaviors among children by providing a vast array of healthy foods offered on the school campus. Current Community Perception: Current community perception regarding school food environment is unknown. Current Level of Community Capacity: School gardens and healthy snack carts are current efforts lead by Olmsted County Public Health Services through the Statewide Health Improvement Plan (SHIP); School Districts. Area of Greatest Opportunity: No specific opportunity regarding school food environment was identified during the CHNA process. What does this Health Factor Impact or Influence? The school lunch and breakfast program contribute to the nutritional intake of children. The structured menu requires a healthy diet high in fruits, vegetables, whole grains, and dairy. Children experience eating balanced meals during formative years which will help establish good eating habits. The school food environment may also contribute in positive or negative ways to the nutritional habits and caloric intake of students. When school policies favor healthy classroom snacks, celebrations, vending, and fundraisers, children are exposed to fewer high calorie, non-nutritious foods and beverages, thus supporting the nutrition education messages they learn in school. *NOTE: School Food Environment is an important health indicator for Olmsted County; however, some sections are currently blank due to limited, local data sources. 8
Trend Data with Goal: Over the past few years, Olmsted County Public Schools have seen an increase in both school nutritional gardens and healthy snack carts. Currently (2012-2013 school year), approximately one out of every five schools (19%) has a nutritional garden; there are currently seven nutritional school gardens in Olmsted County. Among all public elementary schools, 25% currently have a healthy snack cart program (5 out of the 20 elementary schools). Healthy People 2020 has a broad nutrition and weight goal of promoting health and reducing chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. A specific objective around healthier food access is to increase the proportion of schools that offer nutritious foods and beverages outside of school meals. Two associated metrics are: to increase the proportion of schools that do not sell or offer calorically sweetened beverages to students; and to increase the proportion of school districts that require schools to make fruits and vegetables available whenever other food is offered or sold. Olmsted County School Food Environment 7 School Nutritional Gardens 5 Elementary Snack Carts 19% 25% Health Inequities: Limited local data is available this data does not allow for any demographic data breakdown, therefore differences between subpopulations is not available. School Food Environment 9
Physical Activity Definition: For this assessment, physical activity is a combination of moderate and vigorous physical activities assessed through the 2013 CHNA Survey. Individuals were asked: During an average 7-day week, whether at work, at home, or anywhere else, how many days do you get at least 30 [20] minutes of moderate [vigorous] physical activity throughout the day? National guidelines for adults are met (not including muscle strength training) when an individual has at least 150 minutes (ex: 5 days of 30 minutes) of moderate activity or at least 75 minutes (ex: 4 days of 20 min) of vigorous activity. Current Community Perception: According to the 2013 CHNA Survey, obesity was cited as the most pressing community health issue impacting Olmsted County. Additionally, individuals believe that workout information, exercise, and weight loss are top types of public health information that would be useful for them or their family. Physical activity was discussed during the community listening sessions and was mentioned as a top theme within preventive care and activities. Data Sources: Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System (BRFSS); Healthy People 2020; Olmsted County Community Health Needs Assessment (CHNA) 2013 Survey Community Health Importance: Regular physical activity can improve the health and quality of life of all ages, regardless of the presence of a chronic disease or disability. What does this Health Factor Impact or Influence? Among adults, physical activity can lower the risk of: early death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, breast and colon cancer, falls, and depression. Current Level of Community Capacity: Current initiatives include: Statewide Health Improvement Program (SHIP); Worksite Wellness. Area of Greatest Opportunity: Physical activity levels are positively affected by structural environments, such as the availability of sidewalks, bike lanes, trails, and parks and legislative policies that improve access to facilities that support physical activity. 10
Trend Data with Goal: The percentage of Minnesota and US adults engaging in moderate physical activity has generally increased over the past decade. According to the most recent survey data available (BRFSS, 2009), just over 50% of both Minnesota and US adults are meeting the moderate physical activity guideline. Information gathered from the 2013 CHNA Survey indicates that 48% of Olmsted County adults currently meet the recommended national guidelines for moderate physical activity. [Interpret local data with caution due to asking number of days/week physically active, not minutes/week.] Healthy People 2020 has a broad physical activity goal of improving health, fitness, and quality of life through daily physical activity. One specific objective is to increase the proportion of adults who engage in aerobic physical activity of moderate intensity, vigorous intensity, or combination of both from the baseline of 43.5% (2008) to 47.9%. [Note: the graphic shows this HP 2020 objective; however, measurements are not identical across populations, therefore interpret with caution.] Health Inequities: Factors negatively associated with adult physical activity include: advancing age, low income, lack of time, low motivation, rural residency, perception of great effort needed for exercise, overweight or obesity, perception of poor health, and being disabled. These inequities are also seen with Olmsted data for example, 37% of people self-reporting as overweight meet the guidelines as compared to 57% of self-reported right weight. Physical Activity 11